Table 4

Implementation Phase: Key Themes According to Leadership Element

Modeling LeadershipFacilitative LeadershipAdaptive Leadership
Coaching in Lean management pushed leaders to formalize rounding visits to clinic-level leaders. Top leaders noted that these rounds seemed overly structured and not “friendly,” but clinic-level management liked leaders’ interest in the details of their work and what they were expected to present when top leaders visited the clinic.Leaders purposefully involved key staff—directors, quality managers, physician leaders, frontline medical and allied health professionals, and office personnel— throughout their organizations in learning collaborative training sessions.
The leaders and champions viewed themselves from the beginning as advocates of the model, cocreating a change process through inspiration and advice, rather than through a top-down approach of dictating change.
Communication structures were organized to avoid a top-down approach and encourage participation of all staff.
Learning collaborative seminars and workshops spread expertise from experts to beginners.
Learning collaborative seminars provided dedicated time for organizations to meet by themselves to discuss lessons, and align and set organizational priorities.
Participation in Safety Net Medical Home Initiative focused on development of technical expertise.
Metrics underlying reimbursement incentives were continually reviewed in steering committee meetings as implementation matured.